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Youth Services Family Information/Waitlist Form
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Livermore Area Recreation and Park District
Youth Services Division
71 Trevarno Road
Livermore CA 94550
Phone:
925-960-2480
Email:
youthservices@larpd.org
Youth Services Family Information/Waitlist Form
Extended Student Services (ESS) Elementary School
PAL Middle School
*
Primary Family Email Address
Mother's Name
Mother's Email Address
(If different from the Primary email address)
Mother's Primary Phone
Mother's Secondary Phone
Father's Name
Father's Email Address
(If different from the Primary email address)
Father's Primary Phone
Father's Secondary Phone
Address
City
State/Province
-------
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
-------
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Zip Code
Preferred Language
Please List All Children
Child #1 Name
Child #1 Birth Date
Child #1 Year Starting
Child #1 Grade
TK
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
Child #1 Home School
Altamont Creek
Arroyo Seco
Jackson
Marylin
Lawrence
Rancho
Smith
Christensen
East Avenue
Junction Middle School
Mendenhall
Croce
Michell
Sunset
Child #2 Name
Child #2 Birth Date
Child #2 Year Starting
Child #2 Grade
TK
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
Child #2 Home School
Altamont Creek
Arroyo Seco
Jackson
Junction
Marylin
Michell
Lawrence
Smith
Sunset
Christensen
Rancho
Junction Middle School
Mendenhall
East Avenue
Croce
Child #3 Name
Child #3 Birth Date
Child #3 Year Starting
Child #3 Grade
TK
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
Child #3 Home School
Altamont Creek
Arroyo Seco
Croce
Jackson
Junction
Marylin
Michell
Lawrence
Rancho
Smith
Sunset
Christensen
East Avenue
Junction Middle School
Mendenhall
Child #4 Name
Child #4 Birth Date
Child #4 Year Starting
Child #4 Grade
TK
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
Child #4 Home School
Altamont Creek
Arroyo Seco
Croce
Jackson
Junction
Marylin
Michell
Lawrence
Rancho
Smith
Sunset
Christensen
East Avenue
Junction Middle School
Mendenhall
Is your child already attending an LVJUSD school?
Yes
No
Do you think you qualify for subsidy assistance?
Yes
No
Tuition assistance is based on a sliding scale.
If you feel you may be eligible for tuition assistance, please indicate your total gross family monthly income
If you feel you may be eligible for tuition assistance, please indicate you family size: #Adults/#Children
Comments or Questions
Your application will be dated upon receipt and you will be contacted when there is an opening at your home school site or the school your student is currently enrolled in.
Submit
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